| NPI | 1649273574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA TP005727C) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA TP005727C) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-03-03 |